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Coldwater Board of Public Utilities Authorization for Automatic Bill Payment

  1. Coldwater Board of Public Utilities Authorization for Automatic Bill Payment

  2. I (We) hereby authorize Coldwater Board of Public Utilities, hereinafter called Company, to initiate debit entries to my Checking/Savings account* indicated below and the Financial Institution named below, hereinafter called bank, to debit the same to such account.

  3. Acct Type*

  4. This authority is to remain in full force and effect until company has received written notification from me of its termination in such time and in such manner as to afford Company a reasonable opportunity to act on it.

  5. Please attach a photo of a voided check or savings account deposit slip signed with your signature.

  6. Digital Signature*

    I acknowledge that I have read, understand, and will abide by the procedures above.

  7. Leave This Blank:

  8. This field is not part of the form submission.